PDF(Pubmed)
Abstract：
Background: Acupuncture may be a promising complementary therapy for vascular cognitive impairment (VCI) and has been extensively applied in China. However, its potential effects remain uncertain, and the clinical findings are inconsistent. This review aimed to systematically appraise the overall effectiveness and safety of acupuncture in treating VCI. Methods: To investigate the effects of acupuncture on VCI from inception to February 28, 2021 using randomized clinical trials (RCTs), seven electro-databases [Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), VIP, and Wanfang] were searched. Two independent investigators identified the eligible RCTs and extracted data into predesigned forms. The risk of bias (ROB) within each individual trial was evaluated using the Cochrane Collaboration\'s tool. Meta-analyses were conducted for calculating comparative effects in the RevMan software (version 5.3). The strength of attained evidence was rated using the online GRADEpro approach. Results: A total of 48 RCTs involving 3,778 patients with VCI were included. The pooled data demonstrated that acupuncture was more beneficial for a global cognitive function [mean difference (MD) 1.86, 95% CI 1.19-2.54, p < 0.01] and activities of daily living (MD -3.08, 95% CI -4.81 to -1.35, p < 0.01) compared with western medicine (WM). The favorable results were also observed when acupuncture was combined with WM (MD 2.37, 95% CI 1.6-3.14, p < 0.01) or usual care (UC, MD 4.4, 95% CI 1.61-7.19, p = 0.002) in comparison with the corresponding control conditions. Meanwhile, the subgroup analysis did not indicate a statistical effect difference between manual acupuncture (MA) and electroacupuncture (EA) (inter-group I 2 < 50% and p > 0.1) when comparing acupuncture with WM. There were no significant differences in the occurrence of adverse events (AEs) between the acupuncture group and the control group (p > 0.05). Owing to the poor methodological quality and considerable heterogeneity among studies, the certainty of the evidence was low or very low. Conclusions: This review suggests that acupuncture as a monotherapy or an adjuvant therapy may play a positive role in improving the cognition and daily performance of VCI patients associated with few side effects. The difference in styles may not significantly influence its effectiveness. More rigorously designed and preregistered RCTs are highly desirable to verify the therapeutic benefits and determine an optimal acupuncture paradigm. The methodological and reporting quality of future researches should be enhanced by adhering to authoritative standardized statements. Systematic Review Registration: [PROSPERO], identifier [No. CRD42017071820].
摘要：
背景：针灸可能是治疗血管性认知障碍（VCI）的一种有前途的补充疗法，在中国已得到广泛应用。然而,其潜在影响仍然不确定，和临床表现是不一致的。本文旨在系统评价针灸治疗VCI的总体有效性和安全性。方法：使用随机临床试验（RCTs）研究针刺对VCI的影响，从开始到2021年2月28日，七个电子数据库[科克伦对照试验中央登记册(中央)，PubMed,Embase,中国国家知识基础设施(CNKI),中国生物医学文献数据库(CBM),VIP,和万方]被搜查了。两名独立研究人员确定了合格的随机对照试验，并将数据提取到预先设计的表格中。使用CochraneCollaboration的工具评估每个单独试验中的偏倚风险(ROB)。在RevMan软件（5.3版）中进行Meta分析以计算比较效果。使用在线GRADEPro方法对获得的证据的强度进行了评估。结果：共纳入48个RCTs，涉及3,778例VCI患者。汇总数据表明，与西药（WM）相比，针灸对整体认知功能[平均差异（MD）1.86，95％CI1.19-2.54，p<0.01]和日常生活活动（MD-3.08，95％CI-4.81至-1.35，p<0.01）更有益。当针灸与WM（MD2.37，95％CI1.6-3.14，p<0.01）或常规护理（UC，与相应的对照条件相比，MD4.4，95％CI1.61-7.19，p=0.002）。同时,亚组分析显示,当针刺与WM比较时,手动针刺(MA)和电针(EA)之间没有统计学效应差异(组间I2<50%,p>0.1).针刺组与对照组的不良事件(AEs)发生率差异无统计学意义(p>0.05)。由于方法学质量差和研究之间相当大的异质性，证据的确定性很低或很低。结论：本综述表明，针灸作为单一疗法或辅助疗法可能在改善VCI患者的认知和日常表现方面发挥积极作用，副作用少。风格的差异可能不会显着影响其有效性。非常需要更严格设计和预先注册的RCT来验证治疗益处并确定最佳的针灸范例。应坚持权威的标准化声明，提高未来研究的方法和报告质量。系统审查注册：[PROSPERO]，标识符[编号CRD42017071820]。
